Welcome to Proven Pathways!
Please fill out our confidential form so we can learn more about you. This will help us have a conversation with you about our practice and how we could address your needs. We will endeavor to return your contact within one business day.
How did you hear about our practice?
We offer both in person and Telehealth services to clients in Ohio. If you will be seeking Telehealth services while physically in a state other than Ohio, please list any and all states that may apply (excluding brief trips, vacations, etc.)
Please check your insurance and we can have a discussion with you about what to expect (note: for state employees, you likely have Optum for behavioral health, which we are not in network with):
I am out of network, but would like to self-pay
Aetna
Meritain
Cigna
Medical Mutual
OhioHealthy
Devoted Health
Tricare (we are a certified out-of-network provider)
Please note the following self-pay fees, and select the option that works best for you:
Licensed Psychologist (45 min: $220; 60 min: $285)
Licensed Clinical Therapist (45 min: $200; 60 min: $275)
Pre-licensed Postdoctoral Fellow (45 min: $200, 60 min: $275)
Open to recommendation based on my needs and availability
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please provide the best times to reach you today and tomorrow. If you're completing this form over the weekend, please list your availability for Monday and Tuesday.
What is your age? We typically see clients 18 years and older but depending on the case can see between ages 15-17 as well.
Please briefly describe the primary reasons you are seeking treatment:
In the past two weeks, how often have you been bothered by the following problems?
Not at all
Several days
More than half the days
Every day
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying/obsessing
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Have you in the past received any mental health diagnoses?
Have you been tested for, or received a diagnosis of, a neurodevelopmental disorder in the past (e.g., autism spectrum disorder, ADHD, learning disorder)?
In the past 6 months, I have participated in the following treatment for my mental health:
Therapy (outpatient)
Psychiatric medication management
Intensive outpatient treatment (IOP)
Partial hospitalization program or day program (PHP)
Residential treatment
Inpatient mental health treatment
Other
With the right kind of treatment, I think I could make progress with improving my mental health.
Yes
No
Submit
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